New, federally funded pool for high-risk people without health insurance kicks off Thursday

Lee State Bureau

by Mike Dennison

HELENA — Starting Thursday, several hundred Montanans with high-risk health conditions and no insurance can sign up for a new insurance pool, which is part of the federal health-reform bill passed in March.

Slots in the pool, known as the Montana Affordable Care plan, are expected to go quickly, said the state’s insurance commissioner, state Auditor Monica Lindeen.

“Montanans who think they will be eligible for the new program should act fast,” she said. “Spots are limited and we want those most in need to get coverage.”

Applicants, who must have a pre-existing health condition and been without health insurance for least six months, can find an application at www.mthealth-org.

Montana is one of only two states so far to sign a contract with the federal government to launch the new pool by July 1, Lindeen said Tuesday. The other is Pennsylvania.

As part of the health-reform bill, the federal government is funding the high-risk insurance pool through the end of 2013. Montana has been allocated $16 million, which Lindeen said should be enough to cover about 400 people.

Lindeen said she has little doubt a need exists for the lower-cost insurance, and that it’s likely that the demand will outstrip the funding. Slots will be available on a first-come, first-serve basis.

“We know there are people out there with pre-existing conditions that have not been covered,” she said. “(Insurance) agents are telling me that people are asking about this (new pool) all the time: ‘When’s it going to be available?’ ”

The insurance, designed to cost the same as coverage for someone without a pre-existing condition, will cost from $190 to $615 a month, depending on a person’s age. The annual deductible will be $2,500 and, after that deductible is met, the policy pays 70 percent of the cost of services provided by health professionals within the provider network.

The maximum annual out-of-pocket payout for someone covered by the policy will be about $6,000.

Generally, the health insurance offered by Montana Affordable Care will be less expensive than insurance offered by Montana’s existing high-risk pool, the Montana Comprehensive Health Association.

MCHA, financed in part by fees on Montana’s insurers, has been considered the coverage of last resort for people with high-risk health conditions who’ve been denied by other insurers or who can’t find coverage for any less.

Those covered now by MCHA won’t be eligible for the new, less-expensive plan because they’re not currently without health insurance.

When asked whether the new program creates an inequity for those covered by MCHA, Lindeen said “there are a lot of inequities in the existing insurance market.”

“There’s a lot of hope that, over the course of the next several years, that as health-insurance reform is implemented, that a lot of those inequities will disappear,” she said.

Lindeen noted that the high-risk pool is seen as a temporary fix to help some people with coverage until wider reforms take effect in 2014, with more subsidies to help people buy insurance and new health-insurance “exchanges” that will offer affordable products to a wider array of people.

“We all wish that all the reforms could take effect immediately, but it’s just going to take time,” she said.